Print This Form To Place Your Order By Mail

  PLEASE PRINT CLEARLY
Name:                                                                                                                     
Address:                                                                                                                               
Address:                                                                                                                     
City:                                                   State:                    Zip:                
Phone:                                                   Email:                                                
Payment By           Check            Money Order          
Quantity             at $99.95 each.    Total:    $                  
 (UPS Ground Service Only) Shipping & Handling:    $    9.95
(California only) Sales Tax  8.25%:    $                         
Total Enclosed:    $                         

Make Payable and Mail To:

Welcome Home Day Foundation 
12335 Santa Monica Blvd.
Suite 103
Los Angeles CA 90025

310-281-8339